Vera Posted Mon 22nd of April, 2013 19:16:54 PM
I have been told at a seminar that you cannot bill a 99214 (or 99204) for podiatry - that there's no way that a podiatrist can cover all the systems, in order to validate a 99214 (or 99204). What code would you use when a patient takes an extremely large amount of your time? Sometimes the Dr. is in the room for 45-60 min with a patient, and I think he should be compensated at a level greater than 99213 or 99203? Ideas?
SuperCoder Answered Tue 23rd of April, 2013 20:24:28 PM
My editor is working on this. She will get back with the answer soon.
SuperCoder Answered Wed 24th of April, 2013 01:08:56 AM
E/M codes are not specific to certain types of providers. A podiatrist can bill any level of office visit code, provided his documentation supports that level and that the documented history and exam are medically necessary to the patient's problem.
If you are going to code based on the key elements of history, exam, and medical decision making, you need to achieve the levels in the code descriptors. For example, for a 99204 you need comprehensive history, comprehensive exam, and moderate complexity medical decision making. It sounds like your concern is the exam portion. While it may be true that a podiatrist isn't going to do a head to toe comprehensive exam, he may do a comprehensive exam per the 1997 musculoskeletal or neuro specialty specific exams. You can find these listed in the 1997 E/M Guidelines here on Supercoder: http://www.supercoder.com/exclusives/cms-center/evaluation-management. Or check out the handy sheets at https://www.novitas-solutions.com/em/scoresheets.html.
The other thing to think about is whether counseling and/or coordination of care dominate the visit. If your podiatrist is spending large amounts of time with the patient and more than 50% of that time is spent on counseling or coordination of care, you might be able to bill based on time. You should only code an E/M service based on time alone if at least 50 percent of the visit was spent on counseling or coordination of care, and this fact must be noted in the documentation. The documentation must contain the following three elements:
• Notation of the total time spent on the encounter
• Notation of the total time spent on counseling and/or coordination of care or the percentage of the visit spent on counseling/CoC
• The reason for/topic of the counseling/CoC
I hope this helps.
Leesa A. Israel, BA, CPC, CUC, CMBS
Executive Editor, The Coding Institute
Manager, TCI Consulting & Revenue Cycle Solutions